As an Occupational Therapist, I have had the privilege of working in many different fields and another country over my career to date.
This has included working with adults who have learning disabilities, adults with mental health issues, older person’s physical health, acute and rehabilitation neurology and neurosurgical fields, general medicine and orthopaedics.
I reflect on the thread that has run through all these very different areas of work and how vital this has been as my career has progressed.
This has ranged from professional training, professional support networks, special interest groups and specific skill based supervision; continuing professional development though COT and work based training locally and nationally.
The access to and support from senior therapists willing to share their own experiences, demonstrate practical skills and give generously with their guidance gave me the confidence and time to feel comfortable to settle into the profession I had studied. They guided me to see that the impairments may be different but that the role of the Occupational Therapist can adapt as we have a range of eclectic skills at our disposal, the most important of which are listening and observing, in order that we hear what the patient is seeking and consider the intervention accordingly.
The physical, psychological, behavioural, emotional and environmental reasons why actions and activities cannot be completed – and working with the patients abilities – helps to bridge the barriers and adapt and modify activities to gradually enable greater levels of independence and belief.
I learnt that working as a member of a team is very comfortable for Occupational Therapists, we are team players, we come with a different perspective, and our involvement in the dynamic of an MDT is important and unique.
THE OCCUPATIONAL THERAPIST
The Occupational Therapist is a combination of facilitator, listener, educator, reflector and often creative problem solver. We often find ourselves working alongside a medical model which focuses on the impairment or disability. This model works within the confines of guidance evidenced to manage these issues, but as my professional confidence grew, I felt comfortable working in a different way – but still under the team umbrella.
We have the luxury of being able to step out of that model and exploring with the individual their life, aspirations and significant others in order that we can use this information to facilitate meaningful and patient centred outcomes. We understand the impairment and how the other members of the team’s training will be utilised to affect a change in this situation. But our challenge is to modify and be creative to assist patients and families to see opportunities for change and I feel this is unique to Occupational Therapy.
THE DIFFERENCE OCCUPATIONAL THERAPY MAKES
My experience is that patients find this intervention reassuring and empowering. The Occupational Therapy training gives us a diverse tool kit of skills and knowledge of how and when to engage these skills and provide advocacy for the patient’s life beyond the medical issue being addressed.
OCCUPATIONAL THERAPY AND CASE MANAGEMENT
Some years ago, I had a change of professional pathway and moved into working as a Case Manager. I was concerned that I may lose touch with my clinical intuition and the varied skills that I had honed working alongside and observing incredibly skilled and specialist team members over the last 20 years as an Occupational Therapist. This has not proved to be the case. In fact I think many of the skills I have reflected on are utilised regularly in my current role and are the requirements of a competent Case Manager.
WHAT IS CASE MANAGEMENT?
The definition provided for a case manager is someone who puts the patients at the centre of the process and can work collaboratively to assess, plan, implement, co-ordinate, monitor and evaluate.
This resonates very closely with the philosophy of many Occupational Therapy models in being patient led and encouraging the focus of treatment to be to engage with intrinsically meaningful goals directed by the patient and facilitated by the Occupational Therapist. This is achieved through listening, observing, analysing and drawing on their broad education which covers medical, social behaviour, psychological, psychosocial and occupational sciences. This equips the Occupational Therapist with the attitudes, skills and knowledge to work collaboratively with people and other professionals, encouraging skill “pooling”. This effectively co coordinates a multidisciplinary team approach to attend to the various complex and often traumatic, physical, behavioural, psychological and environmental changes that people experience during vulnerable periods following accident or illness.
SEVEN YEARS AFTER LEAVING OCCUPATIONAL THERAPY
The Occupational Therapist in me feels very comfortable with my move, now seven years in. My role as a Case Manager is not one of a treating clinician, but to use an analogy, is more the “conductor of the orchestra” taking the “score” (being the patient’s goals and motivators) and overviewing the selection of relevantly qualified “musicians “. I am expected to overview the intensity and the quality of the “performance” guided by the feedback from the patient themselves and the audience (family, friends).
The patient requires me to engage all of my professional skills to ensure that I can provide clear evidence of the decisions made together and the efficacy of these decisions. My role as advocate in this process is vital. The Case Manager role is regularly expected to facilitate close working and clear communication across multi agencies such as Private providers, NHS, Social services, the third sector, Department of Work and Pensions; and volunteer agencies which can be challenging, as people work under different pressures and within different frameworks, but ultimately all these parties have the same core values of prioritising patient choice and independence.
Utilising my Occupational Therapy core skills, values, professional code of conduct and professional experiences I feel well equipped to “broker“ positive patient centred goals across many agencies and observe that the Occupational Therapy qualification places us in a great position to work competently as Case Managers.
We are used to writing clear goals, considering cost implications and reviewing processes. I have also noticed that our training allows us to “tune in “well to different professional jargon and interpret this back to patients to ensure that at all times they understand what is on offer and can make informed /educated decisions on what and how they wish to progress their rehabilitation.
I reflect again on the versatility of my training as an Occupational Therapist and am so happy that this was the career I chose. It has provided me with an eclectic skill set that can be applied in such a variety of clinical, educational, private practice, business and social settings. It is continuing to provide me with the opportunity to choose to work in a diverse range of ways and that does feel amazing.